Victory/Victoza
So, I've been fighting my insurance company since January to allow me to renew a prescription for Victoza (Liraglutide, a diabetes drug for type 2 diabetes).
Usually the way these things go, my doc argues with them for a while and then they cover whatever it is they don't want to pay for. This time they denied it twice, and so I had to appeal to the state. In preparing for that hearing, I ran into a bunch of roadblocks, first of all that the hearing packet with all of my insurance company's exhibits was supposedly served March 8, but did not get to me until mid-April, postmarked... mid April.
So it was not until I got that packet, 2 weeks before the hearing date, that I got a look at what they were basing their decision on.
Y'all, it was gobbledegook. Someone had apparently transcribed a phone message while high, or possibly helped by a cat, but it was not intelligible. Or it might have been someone who didn't type well trying to take dictation while I was speaking.
You know I pride myself on clear communication. It was embarrassing, and I'm not sure who it was more embarrassing for. Like I had firsthand embarrassment at those "words" being attributed to me, and secondhand embarrassment for whoever wrote it up.
And my doctor had not sent enough medical records, and the records that were sent were... also badly transcribed. And some were upsetting, such as the comments on the usual stuff that gets rudely commented on in type two diabetics' charts. (I have steroid induced diabetes, not typical type 2, but that's another story.)
It took me more than a week to overcome the mental inertia of knowing I had to do a deep dive into my own medical history, which is inherently traumatic, beating two not entirely merged digital charts into something coherent.
When I finally tackled it, my first draft had 1200 words and there was a spreadsheet with multiple sheets.
Here's what I did:
Went back through the chart to note things like dates of care, messages with the doctor about meds, and correlated the vitals stuff to my blood test dates. This all went in a spreadsheet.
Wrote a narrative countering their assessments (such as my diagnosis being "type two diabetes without complications." Excuse you. I'm very complicated) and making it clear what meds were being taken when and how my A1C responded and what my weight was doing and what my RA situation was and how my body responded to treatments.
Read the instructions for submitting exhibits.
Printed (in light mode!) to PDF both supporting doctors' letters that I had, all of my A1C data for 11 years, my vitals for 3 years, my own narrative, and a digital version of the exhibit list.
Emailed all of that to the hearings assistant, the hearings representative and the insurance company.
What happened:
A few hours after I sent the email (6:30 am was when it went out) I got a call from my hearings representative. She told me she was going to make sure the insurance company read the exhibits.
A couple hours after that, she called me to tell me the insurance company itself had reversed its own decision and was entering the approval for the medication into the system immediately.
A few hours after that, I submitted the refill request to my pharmacy, they were out, so we transferred it to a pharmacy that had it in stock.
And tonight? I got my meds.
Zero copay.
So now i get to ease my blood sugar back down from the 160-180 range over the next couple days, and hopefully stabilize back at the 90-120 range I was at before when I was able to take both Victoza and topical metformin (avoids digestive problems! No side effects!)
I know better than to drop it too quickly, that way lies a confused body acting like 110 is the new 50.
It was maddening knowing how hard I've worked to keep it under control and knowing that we had figured out things that worked and not being allowed to DO those things. Like, I cannot afford to pay $1000 OOP every month for one single medication.
(And before you talk about patient assistance, I am in a category where I absolutely positively do not qualify, end of. That was the first place I looked.)
